Psychiatrists are sometimes heard to say that schizophrenic patients have
“their wires crossed.” To wit, loose associations consist of statements
that reflect intrusive thoughts appearing out of context to an initial
line of thinking. Nevertheless, when traced, each intrusion has its origin
within the thoughts of the patient although the connections are not always
clear.

When properly traced,
each thought separately makes valid sense to the individual. It seems as
if the thinking process is running on one track and switches to another
track. Is this the process that actually occurs?

The neurological
pathophysiological answer is unknown at this time. Hopefully, one day it
will all be clear.

It
appears as if, when these “switched-track thoughts” occur in volume, the
patient complains of confusion and the observer sees a primary thought
order — the essence of this disease.

When a sufferer relates a little story which is out of reality, we often
see simple origins within the person’s life.

An
intense belief that the sufferer is the Archangel Joshua fighting in outer
space against unseen enemies reflects a simple connection between a
sufferer’s wish to aid their friend Joshua who is beset with difficulties
that the sufferer has promised to fix. The underlying affection for
Joshua, the compassion for this friend, and hope for him are clear, but
unstated and unaware to the sufferer.

A
deep understanding by a trained observer makes the story easy to
understand. Those outside the circle might see that only as a delusion; if
visual or auditory, as an hallucination.

In
a different context; if the “wires get crossed” and the formerly
completely peaceful schizophrenic designates a concrete human being as a
dangerous enemy resulting in murder, we call the perpetrator a criminal.

Legal distinctions ask the patient if he knows right from wrong,
demonstrating a tragic misunderstanding of the disease. All analogies are
imperfect. However, one is that of two electrical wires losing their
insulating cover thus causing a short circuit and perhaps a fire. If you
look at other areas of the wired circuits you could not see the short. The
wires act as they do because they are crossed and short out (a disorder of
synchrony?) — not because of right and wrong. It is a simple immutable law
of physics.

A
Turkish fable tells of an individual who passes by a man tossing pebbles
into a lake. He asks the man why he is doing that and the tosser says “I’m
trying to turn the lake into yogurt.” The passerby says “That’s
impossible,” to which the tosser replies, “Yes, but imagine if it were
possible and the lake was yogurt!”

Asking perpetrator
schizophrenics if they understand right from wrong is like tossing pebbles
into the lake. The idea may seem attractive but it is the wrong process —
it is out of reality. This phenomenon of “wires crossing” may be temporary
(“leakage” = a disorder of synchrony) from one axon to another. The axons
are ensheathed in myelin.

But why would there
be leakage, a disorder of synchrony?

If
we suggest that the proper construction of myelin depends on the strength
of various feelings, several speculations arise to an unknown answer.

We
know that myelin is laid down both in greater volume and better quality
when individuals pursue ardent interests such as music, sports, etc.
Genetic factors, varying with each individual, regulate these
constructions. Diffusion tensor imaging (DTI), a type of magnetic
resonance technology can show white matter in action.1 “The
functioning of white matter may be just as critical to how people master
mental and social skills.”1

“Many people who suffer bipolar disorders or schizophrenia have a defect
in the gene that regulates production” (of the protein neuregulin that
coats axons).1

On
the contrary, what factors result in inefficient myelin formation
resulting in later collapse? Are these environmental or genetic factors or
the interplay of both? Is it related to lack of parental compassion for
the child’s feelings, to wanton destruction of the child’s quest for
mastery? Does poor training in how to handle conflicts cause excess
anxiety at some time in the future resulting in failure of the wrappings
of the axons of the nerves that carry our thoughts? “Children who suffer
severe neglect have up to 17% less white matter in the corpus callosum.”1

“Brain volume decrement was due to shrinkage of the neuropil surrounding
the neurons in the gray matter, including reduction in dendrite length by
a half and a decrease in the number and size of dendritic extensions.”2

“The vulnerability of the myelinization process likely
contributes to the unique susceptibility of the human brain to highly
prevalent disorders of development. A dysregulation in this developmental
process is hypothesizedto result in
an insufficient capacity to maintain temporal synchrony of the brain’s
widely distributed functional neural networks and manifests in the
heterogeneity of symptoms and cognitive impairments that characterize
disorders such as schizophrenia.”8

Much research has been made regarding the effects of drug treatment.
”Neurotransmitter actions trigger various neuroplasticity cascades to
rebuild the neural pathways ravaged by recurrent episodes of psychosis or
depression.”2

It
has been suggested that the ability of individuals to cope with and
resolve stress has a genetic basis. Genes determine neurological
structure. Does their influence often vary with various environmental
interactions, including psychological experiences? Schizophrenia has been
thought to evolve when an individual would seek another reality to live in
when they cannot cope with the anxiety of dealing with the real world. Is
it possible that first, there is a genetically determined neurological
deficit in coping with conflict and later, when intense unresolvable
anxiety mounts, further neurological damage occurs causing schizophrenia?

Clinically, many
specialists have seen the following: You call a 40-year-old schizophrenic
who was recently discharged from the hospital at his parents’ home and ask
to speak to the patient. A parent answers, complains that you ask too many
questions, says their child is not there, won’t hand the phone to your
patient, etc., and hangs up. How was that child treated when the child was
four years or four months?

Other diseases may
be related to these issues.

Clinically, many specialists have seen the following: You meet the parents
of an autistic child at their home. They are carrying the one-year-old
child as if they are carrying a burning log. They snuggle the infant’s
head while looking away from the child.

Nevertheless, autism is a neurological disease caused by genetic factors.

Other diseases are caused by failure of the myelin sheaths, the axon
wrappings. Multiple sclerosis is one; neurologists know of many others.

“Autoimmune-mediated demyelination and axonal degradation of the central
nervous system neurons are critical processes in Multiple Sclerosis.”4

“Dyslexia results from disrupted timing of information transmission in
circuits required for reading,” and “brain imaging has revealed reduced
white matter in these tracts.”1 “We’d love to find a way in
which we can address white matter problems early on in childhood in a way
that would help the white matter to mature and the white matter
connections to develop most efficiently.”3

“Peripheral neuropathies may be due to nutritional deficiencies causing
axonal loss and/or demyelination which, when measured by nerve conduction
studies, may show slowing of velocity and/or loss of amplitude.”6

“Wilson’s disease is
related to an abnormality of copper metabolism. Symptoms include tremors,
dystonia, dementia and psychiatric disturbances of all sorts, including
affective disorders, psychoses, personality changes and behavioral
abnormalities.”7

This Hypothesis
pursues increased understanding.
Is it all genetic?

What causes the neurological. process of inefficient myelin, myelin
breakdown and “leakage” (a disorder of synchrony)? Why one person and not
another? Hopefully, further research may lead to better treatment or even
prevention allowing many individuals to have happier lives.

Perhaps the psychological factors are totally unrelated. Or perhaps the
environmental psychological experiences determine how the genes regulate
the neurological processes.

How
many individuals have had similar childhood experiences yet never suffer
from schizophrenia or autism? Patients have their childhood studied in
great detail by specialist scientists. Yet how many non-patients are
studied to that extent?

“Schizophrenia is now understood to be a developmental disorder that
involves abnormal connectivity. White matter is abnormal (possessing fewer
oligodendrocytes than it should) in several regions in the schizophrenic
brain. Many of the mutated genes linked to schizophrenia caused by
aberrant genes were involved in
myelin formation.”1,10

Could it be that other psychotic diseases such as bipolar disorder have
similar origins?

Is
it useful to differentiate two different disciplines within the same organ
— neurology and psychiatry? In some ways, yes, in others, no.

Most of these conundrums end up as two disciplines complimenting each
other — neuropsychiatry.

Further study is required.

I consider it a privilege
to make this contribution.

Postscript

When I read in Scientific American that schizophrenia was a “developmental
disorder that involves abnormal connectivity … white matter is abnormal,”
I felt as if I had been hit with a ton of bricks. This explained many of
the unanswered questions that have drifted along for many years.

I
dashed to my computer and watched as my fingers danced on the keyboard as
a tsunami of stream of excited consciousness flowed until exhaustion took
over. Schizophrenia is a neurological disease! Emotions affect all bodily
processes in many ways including inhibition or stimulation.

Several days later, I had an awakening, best described in an email I sent
to some London friends, a very gentlemanly British solicitor and his
lovely wife. (I had previously sent the paper “Schizophrenia is a
Neurological Disease” to these friends.)

Several days after writing the paper I was awakened at 4:32 am with the
notion that if we consider schizophrenia as a neurological disease, how
would that affect the parents who feel guilty about having caused it?

Also, payment for psychiatric illness in America is not in parity with
other illnesses. However, as a neurological disease one might think it
would be correct to modify that here, in the "Greatest Country in the
World."

Again, if a schizophrenic commits a crime, they are warehoused, costing
$40,000 per year, in prisons and abused rather than placed in a secure
half-way house where patients are given jobs, medication and are
self-supporting. As a neurological disease there may be more interest in a
therapeutic environment.

Regarding the forensic arena pertaining to other neurological diseases, if
an automobile driver has a first-episode epileptic seizure causing trauma
to another person, the driver is not put in jail.

You
live in England where they consider America the “Land of the Savages."
It’s something to think about. While studying medicine in Lausanne, I
spent two summers as a medical extern in Sheffield with their medical
students. I was always fascinated as how civilized the Brits were (I was
raised in the jungles of Brooklyn, New York where one never heard the
words "Thank You" or "Please").

In
Sheffield, on internal medicine rounds, the attending physician would
discuss the case something like this: This is Mrs. A whose husband is
disabled; they have three children so she brings in neighbors’ laundry to
earn a few quid. This is particularly difficult for her as she has
ulcerative colitis which, as you know, often is associated with arthritis,
making her job excruciatingly painful. Our first responsibility is to rid
her of the colitis and then the arthritis.

When I came to America,
the rounds went something like this: The attending physician would stand
at the door of a room where a dozen clinic patients were and say; there’s
the brain tumor, that’s the breast cancer, that one has colitis, that lady
is afraid she has breast cancer so we are going to remove them tomorrow,
there’s the loony with a heart attack who came to the emergency room
several times, no one examined him thinking he was imagining it until one
of the nurses did an electrocardiogram and diagnosed it, etc.

Michael I. Rose, MD, FAPA is a Distinguished
Life Fellow of the American Psychiatric Association, Diplomate in
Psychiatry of the American Board of Psychiatry and Neurology, and
Voluntary Associate Professor Emeritus at the University of Miami School
of Medicine, Department of Psychiatry. During his 45 years of practicing psychiatry, Dr.
Rose has rendered his professional service covering a wide range of
specialties. He is currently practicing neurology, psychiatry and
orthopedic medicine. Please
click here for Dr. Rose's curriculum vitae.

Tell me and I’ll
forget.
Show me and I may not remember.
Involve me and I’ll understand.
Native American Proverb

Don’t walk in front
of me, I may not follow.
Don’t walk behind me, I may not lead.
Walk beside me and be my friend.
Albert Camus (1913-1960)
French novelist, essayist and playwright
1957 Nobel Prize laureate in literature